Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

Med. Newsletter / eBook

Be informed on reform; Newsletter and, if requested, a relevant eBook: "Mgd Care 101 in 2016" (No obligation)

Subscribe to Managing Managed Care newsletter feed

SSL Certificate

All Contents

Pay More; Get Less

This article is posted in: 

The health insurance and managed care industries are strange bedfellows.  Health insurance, however, seems to  work better for health insurance companies than patients, by and large. They, the insurers "like to cite figures showing that 87 cents of every dollar in premiums is spent on medical claims. But a new Senate analysis suggests that for-profit insurance companies are spending much less than that, especially for policies sold to individuals and small businesses.

The Nexus of Quality and Cost

This article is posted in: 

The quality improvement movement has changed its focus from improving the health of patients to obtaining the greatest return for the investment.  Why? Because experience has shown, time and again that the former is beyond our abilities, beyond any 'carrot and stick' approach to patient care, and beyond any contrived incentive realignments.  When it comes to lifestyle management, we fail, miserably.  For instance, getting people to stop smoking, the only thing that has worked is raising the pric

Care Mgm't, Communication Curriculum Tools and Diagnostic Coding

This article is posted in: 

Coding systems that support clinical decision-making, 'measurement and management,' communication, especially about transitions of care and outcomes (acuity-adjusted) become the modus operandi of the new Managed Care.

The Best Diet

This article is posted in: 

Six Cardinal Rules when attempting to lose weight and/or reduce the risk of heart and other diseases You MUST take in (eat) less calories than you burn (exercise and by being active) Portion size must be reasonable; do not eat to satiety; try to eat a fair amount of whole grains, fruits, and vegetables, but consume Fewer carbohydrates, especially refined and high sugar-loaded ones. Enjoy more polyunsaturated fats (e.g., plant oils and fish). Veer away from low-fat dairy products and nuts.

Delaying Shots ⇔ No Benefit; Much Risk

This article is posted in: 

In faith there is enough light for those who want to believe\enough shadows for those who don't [modified quote: Blaise Pascal]  I'm so tired of the excuses some parents make for not giving or wanting to delay vaccinations.  So, here's evidence; take or fight it on faith or consider the recommendation to immunize on time to be scientifically validated, 'best medical advice (BMA).

Avoiding too much medical care

This article is posted in: 

3 poignant cases of overuse, i.e., where over-supply (of docs) leads to over-testing or over-treating .... Goodwin JS, Singh A, Reddy N, Riall TS, Kuo Y-K. [Archives of Internal Medicine; JAMANetwork.com] target="_blank">Overuse of Screening Colonoscopy in the Medicare Population."     Arch Intern Med Published online May 9, 2011.      doi:10.1001/archinternmed.2011.212

Vit D; Reasonable Doses

This article is posted in: 

Warning: high doses of vitamin D isn't necessary and might possibly be harmful. It's time to rethink the levels. Not getting enough vitamin D?  No time or afraid to get too much sun exposure? Here's some evolving science or evidence of what you should or should not do:

Pages